Phaco for IOP control more effective in acute than in chronic primary angle-closure glaucoma

This prospective study included 13 patients (13 eyes) with acute primary angle closure and 10 patients (10 eyes) with chronic primary angle-closure glaucoma who underwent phacoemulsification as an initial procedure to control IOP. All patients had cataracts and peripheral anterior synechiae (PAS) of more than 180 degrees. Phacoemulsification was highly successful in both groups (100 percent for acute and 80 percent for chronic). The mean post-phacoemulsification IOP was significantly lower than preoperative levels in both groups, but it went down much more for the acute group than for the chronic group (about a 43 mm reduction after six months versus a 15 mm reduction for the chronic group; P=0.018). PAS was relieved in 11 of 12 eyes with acute and five of nine eyes with chronic, and the number of hypotensive medications decreased in both groups.

The authors concluded that initial phacoemulsification for short-term control of IOP is more effective in patients with acute than in those with chronic primary angle-closure glaucoma, especially when PAS is greater than 180 degrees, but the use of phacoemulsification for both groups should be investigated further through a large-scale, randomized, controlled study that uses uniform criteria and strict groupings.